Vaccination Decisions Research Articles

The Relevance of Relatives and Friends: Subjective Norms and Social Networks Driving Young Macedonians’ COVID-19 Vaccine Decisions

The Relevance of Relatives and Friends: Subjective Norms and Social Networks Driving Young Macedonians’ COVID-19 Vaccine Decisions

The Social Ecology of Health Beliefs and Misinformation Framework: Examining the impact of misinformation on vaccine uptake through individual and sociological factors

BackgroundMisinformation presents a critical concern for academic and public health discourse, particularly around vaccine response. Before the COVID-19 pandemic, vaccine hesitancy was responsible for decreased immunization uptake for vaccine-preventable diseases. Misinformation connected to the novel COVID-19 vaccine has further fueled vaccine hesitancy in Colorado and the United States. Our study brings together three different perspectives – physicians, public health professionals, and parents – to understand the impact of misinformation on vaccine uptake in Colorado. Our study proposes a framework for combining the Health Belief Model with the Socio-Ecological model to account for societal factors in healthcare decision making. MethodsSemi-structured interviews and focus groups with public health professionals, physicians, and parents (n = 31) were conducted in late spring and summer 2022. Data were coded inductively using thematic analysis. Identified themes were deductively categorized according to the Socio-Ecological Model and Health Belief Model. ResultsUsing a theoretical framework that combined the Health Belief Model and the Socio-Ecological Model, we identified seven factors that influenced vaccine hesitancy in Colorado. Intrapersonal factors included routine vaccine hesitancy connected to perceptions of severity and susceptibility, efficacy, and benefits and barriers to vaccine uptake; interpersonal factors included social networks; institutional factors included mass mediated platforms, portrayals of uncertainty, distrust in institutional sources of information, and political influences in vaccine decision making; and structural factors included economic barriers behind vaccine hesitancy. ConclusionsOur study provides a unique, triangulated, post-positivist perspective on the role of misinformation in vaccine hesitancy in Colorado. The findings provide evidence that misinformation is an important barrier to vaccination uptake and can permeate multiple socio-ecological determinants/characteristics to influence vaccination behaviors including intrapersonal, interpersonal, institutional, and structural levels. We introduce the Social Ecology of Health Beliefs and Misinformation Framework to account for how misinformation may interrupt vaccine uptake.

Understanding COVID-19 vaccination decisions during pregnancy and while breastfeeding in a Canadian province

ABSTRACTBackgroundVaccination in pregnancy is important for preventing illness for mothers and babies; however, vaccine uptake in pregnant individuals is lower than non-pregnant females of fertile age. Given the devastating effects of COVID-19 and the increased morbidity and mortality risk for pregnant individuals, it is important to understand the determinants of vaccine hesitancy in pregnancy. The focus of our study was to explore COVID-19 vaccination among pregnant and breastfeeding individuals and its association with their reasons (psychological factors) for vaccination using the 5C scale and other factors.MethodsAn online survey investigating prior vaccinations, level of trust in healthcare providers, demographic information, and the 5C scale was used for, pregnant and breastfeeding individuals in a Canadian province.ResultsPrior vaccinations, higher levels of trust in medical professionals, education, confidence, and collective responsibility predicted increased vaccine uptake pregnant and breastfeeding individuals.ConclusionsThere are specific psychological and socio-demographic determinants that affect COVID-19 vaccine uptake in pregnant populations. Implications of these findings include targeting these determinants when informing and developing intervention and educational programs for both pregnant and breastfeeding individuals, as well as healthcare professionals who are making vaccine recommendations to patients. Study limitations include a small sample and lack of ethnic and socioeconomic diversity.

The Impact of Bipartisan Bifurcation on Corona Vaccination in the United States

Coronavirus disease 2019 (COVID-19) has bring disastrous impact to people globally. The United States has been among the most affected. COVID-19 and vaccine decision have evolved to a hotly debated topic among American public, as well as Democratic and Republican politicians. While ample research has been conducted on how politicians shape public opinion and behavior, only a few have dive deeper into the specific influence of Democratic and Republican politicians on public views regarding COVID-19 and vaccine decisions. This paper aims to evaluate the impact from these politicians by analyzing the previous research on partisanship, political theory, public opinion and behavior. The paper finds out that contrasting party ideology between Democratic and Republican politicians contribute to differing vaccine decisions. The paper also pinpoints party affiliation as a factor influencing people’s opinion on COVID-19 and vaccine decision. In response, the paper proposes public awareness campaign by NGOs to address the influence of party ideology; promotes bipartisan dialogue and collaboration on COVID-19 to mitigate the effect of party affiliation. Both Democratic and Republican politicians must work together to minimize the political perception of COVID, ensuring it remains a health decision.

Social Media as an Effective Provider of Quality-Assured and Accurate Information to Increase Vaccine Rates: Systematic Review.

Vaccination programs are instrumental in prolonging and improving people's lives by preventing diseases such as measles, diphtheria, tetanus, pertussis, and influenza from escalating into fatal epidemics. Despite the significant impact of these programs, a substantial number of individuals, including 20 million infants annually, lack sufficient access to vaccines. Therefore, it is imperative to raise awareness about vaccination programs. This study aims to investigate the potential utilization of social media, assessing its scalability and robustness in delivering accurate and reliable information to individuals who are contemplating vaccination decisions for themselves or on behalf of their children. The protocol for this review is registered in PROSPERO (identifier CRD42022304229) and is being carried out in compliance with the Cochrane Handbook for Systematic Reviews of Interventions. Comprehensive searches have been conducted in databases including MEDLINE, Embase, PsycINFO, CINAHL (Cumulative Index to Nursing and Allied Health), CENTRAL (Cochrane Central Register of Controlled Trials), and Google Scholar. Only randomized controlled trials (RCTs) were deemed eligible for inclusion in this study. The target population encompasses the general public, including adults, children, and adolescents. The defined interventions comprise platforms facilitating 2-way communication for sharing information. These interventions were compared against traditional interventions and teaching methods, referred to as the control group. The outcomes assessed in the included studies encompassed days unvaccinated, vaccine acceptance, and the uptake of vaccines compared with baseline. The studies underwent a risk-of-bias assessment utilizing the Cochrane Risk-of-Bias tool for RCTs, and the certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) assessment. This review included 10 studies, detailed in 12 articles published between 2012 and 2022, conducted in the United States, China, Jordan, Australia, and Israel. The studies involved platforms such as Facebook, Twitter, WhatsApp, and non-general-purpose social media. The outcomes examined in these studies focused on the uptake of vaccines compared with baseline, vaccine acceptance, and the number of days individuals remained unvaccinated. The overall sample size for this review was 26,286, with individual studies ranging from 58 to 21,592 participants. The effect direction plot derived from articles of good and fair quality indicated a nonsignificant outcome (P=.12). The findings suggest that, in a real-world scenario, an equal number of positive and negative results may be expected due to the interventions' impact on the acceptance and uptake of vaccines. Nevertheless, there is a rationale for accumulating experience to optimize the use of social media with the aim of enhancing vaccination rates. Social media can serve as a tool with the potential to disseminate information and boost vaccination rates within a population. However, relying solely on social media is not sufficient, given the complex structures at play in vaccine acceptance. Effectiveness hinges on various factors working in tandem. It is crucial that authorized personnel closely monitor and moderate discussions on social media to ensure responsible and accurate information dissemination.

The Effect of Parental Vaccine Literacy Level and Attitudes on COVID19 Vaccination Decisions for Children Aged 5-11 Years: A Cross-sectional Study

The Effect of Parental Vaccine Literacy Level and Attitudes on COVID19 Vaccination Decisions for Children Aged 5-11 Years: A Cross-sectional Study

COVID-19 Vaccine for Children: Determinants and Beliefs Contributing to Vaccination Decision of Parents in Germany 2021/2022.

To reduce the number of COVID-19 cases, vaccines were rapidly made available worldwide. For a strategically targeted response to the COVID-19 pandemic, population vaccination coverage was to be maximized. The target groups also included healthy children. In this context, it is important to understand the determinants and beliefs that lead parents to favor or oppose COVID-19 immunization in children. This study aimed to investigate parents' COVID-19 vaccination willingness in Germany for children aged 5-11 years in 2021/2022. For this purpose, the determinants and beliefs behind parents' vaccination decisions were examined. Descriptive analysis and bivariate correlations were performed on COVID-19 vaccination willingness and parents' mental health status, general vaccination attitudes, and SARS-CoV-2 politics perceptions. In total, 2401 participants fully participated in this cross-sectional study. The COVID-19 vaccination uptake (71.4%) outweighed the vaccination refusal (19.4%). Correlations revealed higher vaccine acceptance in parents presenting full vaccination certificates (90.9%), COVID-19 immunizations (99.9%), or increased COVID-19 fear (93.6%). Vaccination-refusal was associated with higher perceived pressure by COVID-19 vaccination campaigns (87.7%), higher experienced restrictions due to COVID-19 protective measures in parents' social environment (83.6%), and engagement against COVID-19 protective measures (51.6%). Besides general anxiety, no significant correlations were observed between parents' mental health variables and vaccination willingness. Although several factors are ultimately associated with vaccination willingness, future vaccination campaigns should prioritize reducing pressure, increasing trust, and considering parents' differentiation between familiar and unfamiliar pathogens during their vaccination decision-making process.

COVID-19 Vaccine Hesitancy in the Perinatal Period: A Survey Among Residents of Hawaii

IntroductionDescribe the vaccination status among people in Hawaiˈi who are attempting pregnancy, currently pregnant, recently delivered (<6 months) and/or breastfeeding and document common concerns and information sources associated with vaccine decision-making. MethodsWe conducted a cross-sectional online survey between April and September 2022 throughout Hawaiˈi. The anonymous surveys were disseminated via flyers and online links posted by physician offices and community partners throughout Hawaiˈi. ResultsFinal analyses included 165 responses. Almost half of respondents (n= 75, 45%) were unvaccinated, 38% (n=62) were fully vaccinated, and 17 % (n=28) of respondents were partially vaccinated. Most influential sources for vaccine decision- making for vaccinated respondents were their healthcare providers (n=28, 45%), and official healthcare organizations (n=22, 36%), while unvaccinated respondents reported friends/family (n=28, 37%) and their healthcare providers (n=26, 35%) as their most influential sources. Top COVID-19 vaccine concerns for unvaccinated individuals were reactions to vaccine (n=78, 76%), and concerns for safety of the vaccine (n=75, 73%). ConclusionsEfforts should be made to increase and expand vaccine education about the benefits and safety of vaccines during pregnancy beyond the pregnant person in order to create more supportive social norms for COVID-19 vaccination in the perinatal period. Consistent and unequivocal support across medical specialties, including obstetrics, pediatrics and family medicine, is also crucial for encouraging uptake of the vaccine during pregnancy or when breastfeeding.

SOURCES OF VACCINE INFORMATION: MISGIVINGS AND TRUST ISSUES AMONG OLDER ADULTS IN NORTH DAKOTA

Abstract Older adults consistently have relatively high vaccination rates. What is not fully understood is how trust in immunization information sources impacts vaccine decision-making among older adults. This study examines older adults’ perceptions and decision-making processes for vaccines such as influenza, pneumonia, shingles, and COVID-19. Older adults (65+) in North Dakota (N=51) who participated in a larger survey study on vaccine behaviors voluntarily agreed to participate in a follow-up phone interview (November 2022-January 2023). Qualitative, semi-structured phone interviews focused on access, knowledge, and decision about vaccines. Interview transcripts were inductively coded for emergent themes related to trust. Three themes were identified: implicit trust in information sources, uncertainty who to trust for vaccine information, and regaining trust in information sources. Implicit trust focused on familiarity with sources of information (such as inherently trusting family members), source expertise (such as doctor recommendations), and reliability of sources (including if the source always provides accurate information). The second theme, uncertainty who to trust, stressed confusion over source inconsistency, such as changing positions on vaccines, or having opposing sources that both seem to be trustworthy. The final theme, regaining trust in information sources, highlighted if and how trust in a source of vaccine information could be recovered, including transparency, sincerity, and verifying immunization information through obtaining a second opinion. These findings contribute to the understanding of vaccine decision-making among older adults and provide focus areas for interventions to address lack of trust in information sources and improve immunization rates for this population.

“The needle is already ready to go”: communities’ and health care professionals’ perceptions of routine vaccination in Nunavik, Canada

ABSTRACT Inuit living in the northern region of Nunavik continue to experience significant health inequalities, which are rooted in colonialism that still have repercussions on their health-related perceptions and practices, including vaccination. This study aimed to explore the perceptions and determinants of routine vaccination among the Inuit of Nunavik by describing factors influencing vaccination decisions from the perspective of community members and health professionals. Semi-structured interviews focusing on the perception of vaccination and experience with vaccination and health services were conducted with 18 Inuit and 11 non-Inuit health professionals. Using the socio-ecological model, factors acting at the community and public policy (e.g. rumours and misinformation about vaccination, language barrier), organisational (e.g. complexity of the vaccination process, staff turnover, lack of specialised vaccination workers and interpreters), and intrapersonal and interpersonal (e.g. past experiences with vaccination, vaccine attitudes, social norms) levels were identified as having an impact on vaccination decisions. Improving vaccination coverage in Nunavik requires a more global reflection on how to improve and culturally adapt the health care and services offered to the Inuit population.

The Governance of Childhood Vaccination Services in Crisis Settings: A Scoping Review.

The persistence of inadequate vaccination in crisis-affected settings raises concerns about decision making regarding vaccine selection, timing, location, and recipients. This review aims to describe the key features of childhood vaccination intervention design and planning in crisis-affected settings and investigate how the governance of childhood vaccination is defined, understood, and practised. We performed a scoping review of 193 peer-reviewed articles and grey literature on vaccination governance and service design and planning. We focused on 41 crises between 2010 and 2021. Following screening and data extraction, our analysis involved descriptive statistics and applying the governance analysis framework to code text excerpts, employing deductive and inductive approaches. Most documents related to active outbreaks in conflict-affected settings and to the mass delivery of polio, cholera, and measles vaccines. Information on vaccination modalities, target populations, vaccine sources, and funding was limited. We found various interpretations of governance, often implying hierarchical authority and regulation. Analysis of governance arrangements suggests a multi-actor yet fragmented governance structure, with inequitable actor participation, ineffective actor collaboration, and a lack of a shared strategic vision due to competing priorities and accountabilities. Better documentation of vaccination efforts during emergencies, including vaccination decision making, governance, and planning, is needed. We recommend empirical research within decision-making spaces.

Heuristics in vaccination Decision-Making for newly developed Vaccines: Understanding the public's imitative behavior

This study aims to investigate the extent to which the public engages in imitative behavior in their vaccination decisions for newly developed vaccines in the Chinese context. Given the crucial role of newly developed vaccines in preventing and controlling the COVID-19 pandemic, a better understanding of how people make decisions about vaccination with new vaccines is important for overcoming vaccine hesitation and promoting widespread adoption of the vaccines. Our results indicate that the public's decision-making about the newly developed vaccine is influenced by a range of heuristics, including a privileged information heuristic, competence heuristic, and consensus heuristic. Specifically, individuals are more likely to imitate the vaccination behavior of those with privileged information, such as insiders, and those with perceived competence in the field, such as experts. Our findings also demonstrate the impact of majority influence, as the popularity of new vaccines leads to an increase in vaccination uptake through herd behavior. Our data highlights the importance of the first movers who are insiders with privileged information or experts with competence, as their behavior can significantly shape the vaccination decisions of others. Our study provides valuable insights into the complex interplay of heuristics and imitative behavior in vaccination decision-making for newly developed vaccines.

Mapping the Cognitive Biases Related to Vaccination: A Scoping Review of the Literature.

Human behavior and understanding of the vaccine ecosystem play a critical role in the vaccination decision-making process. The objective of this study was to understand different cognitive biases that may lead to vaccine acceptance or hesitancy. The eligibility criteria for this scoping review was vaccination-related cognitive bias studies published in the English language from inception to April 2022 and available on PubMed, Embase, and Google Scholar. It included all geographical locations and individuals of all age groups and excluded studies focusing on (i) clinical trials of vaccines, (ii) vaccine research conduct bias, (iii) cognitive delay, or (iv) statistical biases. The search method also included reviewing references in the retrieved articles. Overall, 58 articles were identified, and after screening, 19 were included in this study. Twenty-one cognitive biases with the potential to affect vaccination decision-making were observed. These biases were further grouped into three broad categories: cognitive biases seen while processing vaccine-related information, during vaccination-related decision-making, and due to prior beliefs regarding vaccination. This review identified critical cognitive biases affecting the entire process of vaccination that can influence research and public health efforts both positively and negatively. Recognizing and mitigating these cognitive biases is crucial for maintaining the population's level of trust in vaccination programs around the world.

Fence off Black Swans: The Economics of Insurance for Vaccine Injury*

AbstractBeing injured during vaccination, although infrequent, can occur, and this necessitates understanding the consequences of vaccine injuries. In this study, we analyse the impact of the risk of vaccine injuries, particularly the economic importance of vaccine injury compensation insurance (VICI) programmes for the injured, which few studies have investigated. Specifically, we examine the role of VICI on individuals' vaccination decisions by integrating an imperfect vaccine into an epidemiological‐economic model in the presence and absence of such an insurance mechanism. Our findings show that the risk of being injured is a non‐negligible risk that lowers individuals' incentives to be vaccinated. The introduction of VICI largely alleviates decision‐makers' concern about vaccine injury. Furthermore, our extended discussion shows the effect of insurance in encouraging vaccination persists under some more sophisticated scenarios.

Barriers and drivers of positive COVID-19 vaccination behaviours among healthcare workers in Europe and Central Asia: a qualitative cross-country synthesis

Vaccination uptake is essential to controlling the ongoing COVID-19 pandemic. Healthcare workers (HCWs) play a critical role in receiving, recommending and delivering COVID-19 vaccination. Understanding the specific influences on each behaviour enables the development of targeted and tailored interventions to improve vaccination uptake. This paper presents a qualitative synthesis of HCWs’ individual and context barriers and drivers to these three vaccination behaviours across 10 countries in Europe and Central Asia. Qualitative data from interviews and focus group discussions with 378 HCWs between December 2020 and March 2022 were synthesised and organised by four COM (capability, physical and social opportunity, motivation) factors. Differences by stage of COVID-19 vaccine roll-out (in preparation, early and late delivery) were explored. Receiving vaccination related to all four factors. Recommending vaccination mostly related to capability and motivation. HCWs were generally well-informed by official sources and viewed vaccination as the way to end the pandemic, acknowledging their important role in this. Colleagues, family and friends were positive influences on personal vaccination decisions. However, knowledge gaps were evident, particularly amongst nurses who relied on (social) media. Concerns about safety and effectiveness, often connected to knowledge gaps, were heightened by the accelerated timeline for COVID-19 vaccine development and approval. This impeded some HCWs’ motivation to receive and recommend vaccination even in the later roll-out countries. Delivering vaccination was facilitated by support from public health organisations, teamwork and service re-organisation, more evident amongst later roll-out countries. Ongoing high workloads, stress and burnout hindered delivery. Complex and inter-related factors affecting HCWs’ vaccination behaviours were identified. These insights should inform the design of multifaceted interventions (e.g., communication skills training, management support for HCWs’ mental health, and engaging them in decision-making for service redesign); not only for COVID-19 vaccination as it is integrated into routine services but for routine immunization as a whole.

Understanding COVID-19 vaccine hesitancy in vasculitis patients.

To identify the factors that impact COVID-19 vaccine decision-making in vaccine-hesitant vasculitis patients, and compare their perceptions with other rheumatology patients, given existence of data suggesting rheumatology patients may have disease-specific factors that influence their COVID-19 vaccine decision-making. This cross-sectional study surveyed adult rheumatology patients from the Kaye Edmonton Clinic Rheumatology Clinic, in Canada, between June and August 2021, using an anonymous online questionnaire. Survey responses were analyzed for statistical differences using chi-square analysis. The COVID-19 Vaccine Perceptions Survey had a response rate of 70.9%. Of the total 231 respondents, 103 patients were diagnosed with vasculitis. At the time of the survey, 10.6% of vasculitis patients refused to receive a COVID-19 vaccine compared to 6.3% for other rheumatology patients. Compared to other rheumatology patients, vaccine-hesitant vasculitis patients were significantly more concerned about almost every aspect of available COVID-19 vaccines [e.g., safety (p < 0.001), components (p < 0.001)], and feared that they could contract SARS-CoV-2 from a vaccine (p < 0.001). These vaccine-hesitant patients were also significantly less pleased with the government's pandemic response, less confident in healthcare team-provided information (p < 0.001), and more likely to report that healthcare providers had no role in their COVID-19 vaccine decision-making (p < 0.001). Vaccine-hesitant vasculitis patients may have multiple considerations influencing COVID-19 vaccine hesitancy, including vaccine and disease-specific concerns, along with unfavorable perceptions of the healthcare system (government and healthcare providers). Healthcare providers can address some of these concerns by initiating patient-centered discussions around immunizations to help support educated decision-making.

Morality of vaccination: the influence of moral conviction on vaccination decisions

ABSTRACT Vaccine hesitancy persists despite vaccination’s important role in global health. As many vaccines provide social benefits through herd immunity, vaccination decisions can raise moral concerns. Two studies explored the role of moral convictions in vaccination decisions. Study 1 (N = 485) revealed higher vaccination intentions when individuals thought about vaccination in moral terms. Emotions and moral piggybacking positively predicted moral convictions. In Study 2 (N = 1,111), we evaluated the effects of emotional, moral, and scientific pro-vaccination arguments on moral convictions, support for mandatory vaccination, and tolerance of dissenting views. While no group differences were observed, moral convictions were correlated with increased support for mandatory vaccination but also with a reduced tolerance of dissenting opinions. Overall, moral convictions play a small but significant role in vaccination-related decisions. While moral convictions have beneficial effects on compliance, it is crucial not to overlook the adverse consequences, which may lead to a growing societal divide.

Different roles of interpersonal trust and institutional trust in motivating older adults to receive COVID-19 vaccines in Singapore

Since the approvals of several vaccines against COVID-19 by the World Health Organization, a large body of research has studied the determinants of individuals' intention to be vaccinated against COVID-19 in a variety of societies. Vaccine intention is a complex construct rooted in the social context that informs the decision-making process. The underlying reasons for older adults' intention to receive the vaccination is even more important to health authorities in societies with large proportions of older adults. In this paper, we interview 27 women over age 55 in Singapore about their COVID-19 vaccine decision-making. Using a social-ecological framework of trust, we identify factors at both individual and institutional levels that build or undermine trust and underlie older women's decisions to receive COVID-19 vaccinations in an authoritarian regime. Findings show that both interpersonal trust and institutional trust contribute to vaccine uptake, however, trust can also contribute to delays in vaccination. Moreover, a sizable minority of respondents report that they were vaccinated not because of institutional trust, but because they felt compelled to do so. The results shed light on directions for future vaccination campaigns.

Quantitatively Identifying Messaging Topics to Encourage West Virginia nurses’ COVID-19 Vaccination

Nurses are particularly influential to others as it relates to COVID-19 vaccination decision-making and are at higher risk of COVID-19 themselves. Yet, nurses’ COVID-19 vaccination remains suboptimal. This study combines communication science frameworks with a novel conceptualize of identity—identity fusion—to explore why nurses may not vaccinate and what strategies might encourage them to protect themselves from COVID-19. Practicing nurses recruited from the West Virginia Nurses Association (N = 328) were asked about their nursing identity, COVID-19 threat perceptions, vaccination efficacy perceptions, vaccination social norms, and both vaccination and information seeking plans. Findings show that social norms may have particular influence over nurses’ vaccination intentions, though this is unique to nurses who do not view themselves as completely “fused” with the nursing identity. “Fully fused” nurses, on the other hand, may respond well to information conveying their particular risk for COVID-19. Data suggest information on one’s self-efficacy or ability to get vaccinated should be avoided, as it might discourage some nurses’vaccination. Findings are discussed in terms of how identity may influence vaccination.

Midwives’ perceptions of enablers and barriers to pertussis and influenza vaccination in pregnancy and information sharing

Background: Vaccination in pregnancy against influenza and pertussis protects the pregnant woman/person and their infant against severe disease. Aotearoa New Zealand has a lower uptake of vaccination in pregnancy than some other countries, despite this immunisation being publicly funded. Coverage is also inequitable, with Māori, Pacific people, and people from high deprivation areas less likely to be vaccinated. Many barriers exist to vaccinations in pregnancy, e.g., access barriers and lack of knowledge about vaccination. Discussions about recommended vaccines with healthcare professionals, particularly midwives, may have a positive impact on vaccine decision-making. Aim: This study aimed to investigate midwives’ perceptions of enablers and barriers with discussions about vaccinations in pregnancy, barriers to vaccination in pregnancy, and influences on vaccine decision-making in pregnancy. The study also aimed to gather midwives’ insights into what might improve vaccination uptake. Method: A structured questionnaire was developed containing a mix of closed and open-ended questions. The questionnaire was sent out to 3002 midwives registered in Aotearoa New Zealand in October 2021, using REDCap electronic data capture tools. Simple descriptive statistics were undertaken on the quantitative data. The answers to the open-ended questions were analysed using a direct, qualitative content analysis approach. Findings: Fifty-one midwives’ responses were included in the analysis (1.8% response rate). Almost all reported sufficient knowledge of vaccinations in pregnancy but had varying levels of confidence when discussing them. The most common enablers to conversations were good relationships, easy communication, and having the time and resources available. Respondents perceived that barriers to conversations were negative preconceptions, communication difficulties and lack of time. Lack of awareness, cost to access services and competing priorities for time were also thought to reduce the likelihood of vaccination in pregnancy. To improve vaccine uptake, respondents identified the need for accessible and suitable vaccination venues, appropriate information and the support of all healthcare professionals involved in maternal healthcare. Conclusion: Midwives surveyed understand the importance of vaccination in pregnancy but there may be lack of confidence, time or resources to effectively engage in discussions. A trusting relationship is important but this can be affected by disengagement or late presentation to healthcare services. Resources to counter pre-existing negative ideas and support communication would help midwives to provide useful information about vaccination. Furthermore, respect and cultural understanding of hapū Māori and their needs will positively support their ability to make informed decisions.